Alcohol-related injury death and alcohol availability in remote Alaska

Context.-Injury is a major public health problem in Alaska, and alcohol consumption and injury death are associated. Objective.-To determine the association between injury death, particularly alcohol-related injury death, and alcohol availability in remote Alaska. Design, Setting, and Participants.-Survey using death certificate data and medical examiner records to compare mortality rates for total injury and alcohol-related injury during 1990 through 1993 among Alaskans aged 15 years and older who had resided in remote villages of fewer than 1000 persons. Main Outcome Measures.-Rate ratios of injury death among residents of wet villages tie, those without a restrictive alcohol law) as compared with injury death among residents of dry villages tie, those with laws that prohibited the sale and importation of alcohol). Results.-Of 302 injury deaths, blood alcohol concentrations (BACs) were available for 200 deaths (66.2%). Of these, 130 (65.0%) had a BAC greater than or equal to 17 mmol/L (greater than or equal to 80 mg/dL) and were, therefore, classified as alcohol related. The total injury mortality rate was greater among Alaska Natives from wet villages (rate ratio [RR],1.6; 95% confidence interval [CI], 1.3-2.1), whereas this difference was not present for nonnatives (RR, 1.1; 95% CI, 0.3-3.8), For Alaska Natives, the alcohol-related injury mortality rate was greater among residents of wet villages (RR, 2.7; 95% CI, 1.9-3.8) than among residents of dry villages. The strength of this association was greatest for deaths due to motor vehicle injury, homicide, and hypothermia. Conclusions.-Although insufficient data existed to adjust for the effects of all potential confounders, residence in a wet village was associated with alcohol-related injury death among Alaska Native residents of remote Alaska villages. These findings indicate that measures limiting access to alcoholic beverages in this region may decrease alcohol-related injury deaths.